Meet the Instructors

Antoine Flahault

Professor of Public Health and Director of the Institute of Global Health (Faculty of Medicine, University of Geneva) and co-Director of Centre Virchow-Villermé (Université Paris Descartes)University of Geneva and Université Paris Descartes – Sorbonne Paris Cité

Rafael Ruiz De Castañeda

Institute of Global Health - Faculty of MedicineUniversity of Geneva

Defeating Ebola Together Week 1: Understanding the Disease
"Infection Control in West Africa: From Hand Hygiene to Funeral Rites"

The biggest challenge, actually, relates to the importance, the frequency and the impact of infections associated with medical care in Africa.

I often say that when it comes to Africa, the silence is deafening.

Silence because there are no reliable data, no data at all in fact; and deafening because we, who work in the healthcare systems,

experience this problem and its consequences on a daily basis.

To fight this problem, the most important thing here,

in terms of prevention, is hand hygiene.

Hand hygiene is something we can achieve.

Especially since the WHO has done so much:

technical guidelines, tools for applying these guidelines...

So the ball is in our court.

This is why, at the Infection Control African Network (ICAN), we have decided to take matters into our own hands,

by leading a campaign, alongside and in collaboration with the WHO,

called "Make Africa Orange," which aims to get African

healthcare structures to adopt and commit to this hand hygiene improvement initiative.

Now, as far as current events are concerned, the Ebola epidemic has been confirming what we already suspected:

that infection control is a weak link which must absolutely be strengthened.

"How would you describe the challenge that infection control represents for Africa?"

As far as infection control is concerned, having personally spent three to four months in a country

struck by the epidemic, I was able to witness and assess the inadequacy

of our healthcare systems in terms of infection control.

And I feel that people have now understood, at least in

Guinea (which is where I was), the need for a strong

response by taking the appropriate measures, which are now being implemented

with a strong focus on effective infection control.

So people have become aware of the importance of infection control.

I hope that this epidemic will allow us to create a more solid and a safer foundation for bringing effective infection control to Africa.

"What are the biggest challenges for the countries struck by the Ebola epidemic?"

In the countries concerned, as I was saying, people were very much taken by surprise, because this was not a disease previously active in the region,

so the healthcare systems were totally unprepared

and the epidemic hit them very brutally.

This created a shock, one for which none of the key actors were prepared:

neither the healthcare systems nor the local populations themselves,

who play in important role. But things have improved.

It has now been one year since the epidemic first appeared, and the healthcare systems, in particular, have learned a lot and
are now correcting their mistakes.

Yet a big problem remains, and it's a much more complex problem: the local population.

Local populations are a major actor -- they have beliefs,

they have habits, they have customs, and we continue to face

difficulties in obtaining the necessary response from them.

"What are some examples of local customs liable to interfere with efforts to manage the crisis?"

Many customs have actually exacerbated the situation.

As you know, at the moment someone dies from Ebola,

they are extremely contagious, i.e., the disease has reached an extremely contagious phase. So the corpses are themselves extremely contagious.

But for the people of West Africa, for the family,

the body is considered a sacred symbol.

Some people are even buried at home.

This makes it impossible to follow the proper guidelines: cremating the body,

not touching the body -- these guidelines are very hard to apply among West African populations.

So what happens is people hide infected individuals, and when they die,

they are buried and handled with bare hands, and the chain of contamination goes on unbroken.

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